1430 - Gaba-pending Trouble: A Case of Gabapentin-Induced Hepatotoxicity in a Patient with Prior History of Alcohol Dependence

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

FA

Faraz A. Attar, DO

Resident Physician
Corewell Health Taylor
Canton, Michigan, United States

Co-Author(s)

JJ

Jungyoon Jung, MD

Resident Doctor
Corewell Health Taylor Hospital
Dearborn, Michigan, United States
KH

Kaitlyn Hansen, MD

Resident Physician
Corewell Health Taylor
Taylor, Michigan, United States
RS

Riley Smith, MD

Brain Injury Medicine Fellowship Program Director
Corewell Health Taylor
Taylor, Michigan, United States
ZM

Zeeshan Muzammil, n/a

Medical Student
Rosalind Franklin University of Medicine and Science
Taylor, Michigan, United States

Submitter(s)

FA

Faraz A. Attar

LECOM
Lombard, Illinois, United States

Case Diagnosis: Gabapentin is likely to cause acute transaminitis in a patient with a prior history of alcohol abuse

Case Description: A 51-year-old male presented with bilateral lower extremity numbness, tingling, and weakness. Since beginning IPR, the patient had signs of acute liver toxicity due to elevated LFTs. He had a pertinent past social history of alcohol abuse but stopped drinking in 2022. During his admission, he was started on gabapentin 100 mg to address his neuropathic nerve pain and acetaminophen 325 mg. We discontinued his acetaminophen on the suspicion that it was contributing to liver toxicity due to overuse. However, we still noticed an elevated trend in his liver enzymes.

Discussions: This case provides a unique perspective on neuropathic pain management in rehabilitation patients, specifically in patients with a prior history of alcohol abuse. Despite being started on low-dose gabapentin, the patient showed symptoms of liver injury. Discontinuing acetaminophen didn’t seem to have an impact either. Liver enzymes should be closely monitored on patients with gabapentin especially if they have a history of alcohol use. Our team decided to discontinue his gabapentin and switch him to amitriptyline 25 mg for neuropathic pain.

Conclusions: This case highlights an excellent example of how managing neuropathic nerve pain is based on the individual needs of a patient. While gabapentin is the mainstay therapy for neuropathic pain, patients with a prior history of alcohol abuse undergoing inpatient rehabilitation may be more susceptible to gabapentin-induced hepatotoxicity even if they quit consuming alcohol. This can lead to more frequent labs being drawn and increased testing, which may disrupt valuable therapy time that patients require. Special caution is needed for starting gabapentin in this patient population, regularly monitoring their liver enzymes to assess drug-drug interaction like acetaminophen and gabapentin. Alternative medications for gabapentin would be amitriptyline, duloxetine, and pregabalin.